Provider Demographics
NPI:1568849040
Name:BUKOWSKI, JON (OTD, R/L)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:BUKOWSKI
Suffix:
Gender:M
Credentials:OTD, R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 B ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2727
Mailing Address - Country:US
Mailing Address - Phone:503-935-0781
Mailing Address - Fax:
Practice Address - Street 1:2435 GREENWAY DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4535
Practice Address - Country:US
Practice Address - Phone:503-362-5918
Practice Address - Fax:503-361-2650
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist